MANILA — In the three months since his election as World Health Organization director-general, Tedros Adhanom Ghebreyesus has crisscrossed the globe on official visits. Few, however, are likely to lay the groundwork for a changing relationship more than his state visit to China, during which WHO proposed an ambitious addendum to China’s foreign development plans. Should Beijing take the suggestion, dozens of countries in Asia and Africa may well see a much-needed boost in their ability to combat deadly outbreaks and infectious diseases. And with China taking a greater leadership role, WHO may gain a greater impact than ever.

Just six weeks after his July 1 appointment, Tedros led the WHO delegation to the Belt and Road Forum for Health Cooperation. During the two-day conference, Tedros used the opportunity to press Beijing to become a leader in global health as it rolls out its $900 billion “new silk road.”

At talks with Chinese officials — including Premier Li Keqiang and National Health and Family Planning Commission Minister Li Bin — Tedros stressed the investment opportunities in global health. The talks signaled his commitment for WHO to play its role of being the “leader of the global health agenda” and his recognition of China’s rapidly growing involvement in global affairs and potential role in global health.

Tedros secured an additional $20 million from the nontraditional donor for WHO’s work. The amount is spread out for five years to 2021, which means Chinese contribution to WHO will increase from roughly $3 million annually to $4.6 million during this period. This comprises both China’s assessed and voluntary contributions to WHO, said Bernhard Schwartlander, the WHO China representative

“That’s [a] 50 percent increase, which is very significant, and a show of commitment to the WHO,” Schwartlander told Devex. He admits it’s not “huge” in terms of absolute amounts, but “we’re hoping that we’d be able to continue the work on our cooperation that they eventually feel that they may be in a position to give larger contribution to support the work of the WHO,” he said.

Health in the Silk Road

In his speech at the forum, Tedros highlighted the increasing incidences and growing complexity of dealing with epidemics, pandemics and disasters, and made the case for a global — rather than local — response. As countries become more connected, chances of an outbreak occurring, likely beyond one’s borders, increase.

“As a community, as countries that are inextricably linked, we are only as strong as our weakest link. And this is why a global initiative that elevates health to the center of economic and social development is immensely encouraging,” he said.

The WHO chief was referring to China’s Belt and Road initiative — also referred to as the Silk Road concept — which has been viewed in international circles as largely political and economic in nature. Health doesn’t figure prominently in China’s development cooperation, especially when compared with its loans and investments in economic infrastructure.

But health, seen in the context of security, is starting to emerge as an important element for cooperation. Early this year, during his visit to the U.N. Office in Geneva, Chinese President Xi Jinping talked about how recent pandemics such as Ebola and Zika have “sounded the alarm for international health security.” He said WHO should take leadership in strengthening work in this area through the sharing of information, practices and technologies, and that the international community needs to “step up” support for public health in developing countries, including in Africa.

“There’s realization that nobody along this Silk Road can be saved, as long as there is an outbreak situation, as long as there is a capacity [issue among countries],” Schwartlander told Devex.

In discussions, Schwartlander said there are “clear plans” and “ideas” that emerged from the conference on how health can be realized in the initiative. One of them is the creation of training networks between institutions from different countries to build institutional and people’s capacity in handling outbreaks and emergencies, an activity China engages in itself. One of the areas where the WHO and the Chinese government have been collaborating is facilitating knowledge exchange and advice between experts in and outside China on issues such as medicine access, price negotiations and patent rights.

“Clearly we would also hope that ... more investments could happen along the line, which may include real investments in building medical emergency teams, for example, which does require buying equipment, training people and even building medical facilities to strengthen these systems overall and laboratories,” Schwartlander said.

But that may not be so far off. The WHO presented Chinese officials with a proposal that includes these types of initiatives, as well as particular countries that WHO proposes — and hopes — China would consider for its aid and investments. Tedros has also discussed this proposal with Chinese officials, including with Chinese Premier Li.

WHO’s proposal

The proposal, seen by Devex, comes in two parts. The first targets more than 40 countries along the Belt and Road, as well as African countries that WHO says are highly vulnerable to infectious diseases and other hazards, but that have limited response capacities. This includes countries along the Mekong; the Philippines; several countries in Central and South Asia; countries that are currently experiencing conflict in the Middle East and North Africa such as Syria and Yemen; Eastern and sub-Saharan African countries such as South Sudan and Somalia; and select countries in Europe.

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The first proposed partnership looks at investments in the areas of early warning, surveillance and detection, such as developing platforms that would make operational and epidemiological information publicly available to decision-makers in the event of an outbreak or potential health emergency. It also proposes building local and regional capacity for disease surveillance, as well as countries’ capacity to implement the International Health Regulations. It looks at strengthening countries’ biosecurity and pandemic influenza preparedness through a focus on immunizations, establishing national laboratory systems and emergency operation centers, having a trained global health security workforce, and cooperating to counter antimicrobial resistance.

The partnership also looks at long-term infectious disease prevention and control strategies, particularly those aimed at eliminating yellow fever epidemics and cholera control. This is timely given the recent outbreaks of yellow fever in countries such as Brazil and cholera in Yemen.

The second part of the partnership looks at 16 countries — all of them also included in the first part of the proposal — that require assistance to ensure the continuation of essential health care services to vulnerable populations caught in the midst of ongoing emergencies or humanitarian crises.

“These people have survived the bullets, but now they are dying of cholera,” Schwartlander said. “That’s also an area where we just have a collective responsibility to give the basic services to these people to save their lives, and at the same time start to build these systems so they can cope better in the future.”

Some of the proposed focus of cooperation and investments in this category overlap with the first. But there are others more specific, such as health financing, including supporting WHO’s Contingency Fund for Emergencies, and tapping into China’s emergency medical teams. China was one of the first countries to send experts during the Ebola outbreak in West Africa, according to Schwartlander.

But while WHO may have spearheaded the proposal, Schwartlander said the health aid agency isn’t necessarily asking China for money to fund its own operations alone.

“It’s a proposal that doesn’t ask, ‘we need money for WHO,’” he explained. Rather, it says “these are our priorities for the world, for our work globally, and there’s a list of countries attached where concrete work needs to happen to keep the world safe, and we would suggest that you consider your investments to be targeted in these countries for these purpose and we’d be very happy to work with you.”

Schwartlander added, “Dr. Tedros, the new DG, very clearly made explicitly in his mandate not just to get the resources for our work plan, to pay the rent, and the salary of people working under WHO. He sees his role as the custodian for health globally, and this is the context in which you have to see this discussion.”

The WHO country representative, however, does see a specific role for WHO in these discussions: as facilitator and adviser. They’ve already been doing this, facilitating high-level visits and exchanges, and seconding Chinese experts to work in countries where WHO has a presence to broaden their experience and engage them in the “international way of working and thinking.”

“There are some very strong commitments [from China] to multilateralism, to look into health as a centerpiece of development. But at the same time, that’s the real challenge. There is no good systems in place that the Chinese can use to do it the way they actually want to do it. So in a sense, they are catching up with the system,” he said.

They didn’t have enough time to go through the details of the proposal and it’s unclear at this point whether China will take inspiration from it for its development cooperation and health investments in Africa and countries in the Belt and Road. But the WHO official said the proposal has been “very well received,” and they’re expecting follow-up discussions to ensue.

About the author

Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.

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